Rheumatic diseases are pathological conditions that affect the joints, the muscles, the tendons, and the nerves. Sometimes rheumatic diseases can even extend into organs such as the heart muscle. These conditions cause pain and inflammation and disability.

Wrist pain

Coenzyme Q10 is a potent antioxidant and anti-inflammatory agent for the treatment of rheumatoid arthritis and fibromyalgia.

In a 2023 review article, Freire de Carvalho and Skare have focused on the beneficial effects of CoQ10 supplementation in two rheumatic diseases:

  • rheumatoid arthritis
  • fibromyalgia

Coenzyme Q10 and Rheumatoid Arthritis

Rheumatoid arthritis (RA) is autoimmune disease. The body’s immune system attacks the joints. RA results in pain, inflammation and swelling of the joints. It is accompanied by stiffness, weakness, a loss of mobility, and, eventually, deformity.

The use of Coenzyme Q10 for RA patients is based on the role of oxidative stress in the development and progression of the disease. Oxidative stress is defined as the imbalance of harmful free radicals and protective antioxidants. In RA, there is an overproduction of harmful free radicals in the joints. This results in cellular degeneration.

The available information about CoQ10 supplementation has been obtained from an evaluation of 143 RA patients with a mean age of 49 years plus or minus 12 years. Three-fourths of the RA patients evaluated were female patients [Freire de Carvalho & Skare 2023].

The daily CoQ10 dosage ranged from 100 mg to 200 mg. The supplementation studies ranged from four to eight weeks in duration. CoQ10 supplementation of the RA patients was associated with the following observed improvements [Freire de Carvalho & Skare 2023]:

  • in DAS-28: disease activity score in 28 joints
  • in ESR: erythrocyte sedimentation rate = blood bio-marker of inflammation
  • in cytokine levels (tumor necrosis factor)

The researchers also noted a decrease in malondialdehyde, a blood bio-marker of the oxidative stress.

Coenzyme Q10 and Fibromyalgia

The researchers evaluated data from 287 fibromyalgia patients. The patients’ age varied from 15 to 52 years. Female patients made up approximately 80% of the study participants [Freire de Carvalho & Skare 2023].

The disease duration of the patients ranged 31 months to 15 years. The CoQ10 dosage in the fibromyalgia studies ranged from 40 mg to 300 mg per day. The duration of the studies ranged from six to 36 weeks [Freire de Carvalho & Skare 2023].

The CoQ10 supplementation was associated with the following improvements [Freire de Carvalho & Skare 2023]:

  • reduced fatigue
  • improved sleep
  • lower tender points count
  • less pain
  • improved Fibromyalgia Impact Questionnaire scores
  • improved mood

Furthermore, the researchers observed that CoQ10 supplementation was associated with a reduction in oxidative stress parameters. The studies of CoQ10 supplementation of fibromyalgia patients did not show any adverse effects of the supplementation [Freire de Carvalho & Skare 2023].

Cordero and Alcocer-Gómez conducted randomised controlled clinical studies of CoQ10 supplementation of fibromyalgia patients in Spain. They used 300 mg of Coenzyme Q10 per day in 20 fibromyalgia patients for 40 days. Their study outcomes showed significant improvement associated with the CoQ10 supplementation [Mantle & Hargreaves 2024]:

  • reduced pain and fatigue (by more than 50%) pain and fatigue
  • improved mitochondrial ATP energy generation
  • reduced levels of oxidative stress and inflammation.
  • reduced symptoms of depression
  • reduced headache symptoms

Rationale for CoQ10 Supplementation in Rheumatic Diseases

Rheumatoid arthritis and fibromyalgia are characterised by mitochondrial dysfunction, oxidative stress, and inflammation. Coenzyme Q10 is important for normal mitochondrial function, it is important as a lipid-soluble antioxidant, and it is important as an anti-inflammatory agent. Accordingly, there is a rationale for the use of CoQ10 supplementation in the management of these disorders [Mantle & Hargreaves 2024].

Conclusion: Coenzyme Q10 Safe and Effective in Rheumatic Diseases

The 2023 systematic review shows that almost all studies that evaluated CoQ10 supplementation in different rheumatic diseases did lead to some benefit without any critical side effects [Freire de Carvalho & Skare 2023].

It is important to use a CoQ10 supplement with documented absorption and bioavailability. There are considerable differences in manufacturer formulations of CoQ10 products [Lopez-Lluch 2019].


Alcocer-Gómez E, Sánchez-Alcázar JA, Cordero MD. Coenzyme Q10 regulates serotonin levels and depressive symptoms in fibromyalgia patients: results of a small clinical trial. J Clin Psychopharmacol. 2014;34(2):277-8.

Alcocer-Gómez E, Culic O, Navarro-Pando JM, Sánchez-Alcázar JA, Bullón P. Effect of Coenzyme Q10 on Psychopathological symptoms in fibromyalgia patients. CNS Neurosci Ther. 2017;23(2):188-189.

Cordero MD, Cano-García FJ, Alcocer-Gómez E, De Miguel M, Sánchez-Alcázar JA. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q₁₀ effect on clinical improvement. PLoS One. 2012;7(4):e35677.

Cordero MD, Alcocer-Gómez E, de Miguel M, Culic O, Carrión AM, Alvarez-Suarez JM, Bullón P, Battino M, Fernández-Rodríguez A, Sánchez-Alcazar JA. Can Coenzyme Q10 improve clinical and molecular parameters in fibromyalgia? Antioxid Redox Signal. 2013;19(12):1356-61.

Freire de Carvalho J, Skare T. Coenzyme Q10 supplementation in rheumatic diseases: A systematic review. Clin Nutr ESPEN. 2024 Feb;59:63-69.

López-Lluch G, Del Pozo-Cruz J, Sánchez-Cuesta A, Cortés-Rodríguez AB, Navas P. Bioavailability of coenzyme Q10 supplements depends on carrier lipids and solubilization. Nutrition. 2019 Jan;57:133-140.

Mantle D & Hargreaves IP. Coenzyme Q10 and autoimmune disorders: an overview. Unpublished manuscript. 2024.

The information presented in this review article is not intended as medical advice. The information should not be used as such.